Jun 8, 2015 - Absentee voting will be allowed by written request to the Election Board Chairman prior to each election.
Application for:
Tribal Membership/Voter Registration Choctaw Nation of Oklahoma P.O. Box 1210, Durant, OK 74702
Phone: (580) 924-8280 or (800) 522-6170 ext. 4030 Fax: (580) 924-4529 Email:
[email protected] Please complete one for ALL applicants. If under 16 years of age, a parent or guardian will need to sign. If 16 years of age and older, the applicant will need to sign for himself/herself. When a member reaches the age of 18 years, he/she will be considered a voter. __________________________________________________________________________________________________ First Name (please print)
Middle
Last
Maiden (cards always issued in maiden name)
____________________________________________________________________________________________________________ Physical Address Mailing Address, if different City ____________________________________________________________________________________________________________ State ZIP Code County Phone Number ____________________________________________________________________________________________________________ Birthday Sex Social Security Number (must be provided) Email: ________________________________________________ I certify that the information given in this application is true. I am eligible to be a member of the Choctaw Nation as defined in the Constitution of the Choctaw Nation of Oklahoma. I understand that false or erroneous information can cause loss of membership. I am not a member of another tribe, nor am I registered to vote with another tribe. Check box if you need a NEW Photo ID card. If you would like an updated Photo ID or do not have a photo on file already, please attach a wallet-sized headshot (similar to a passport photo, not a reproduction from a copy machine). Residents: Residents of the Choctaw Nation 10 ½ county service area will be registered to vote in the district and precinct in which they reside. Absentee voting will be allowed by written request to the Election Board Chairman prior to each election. Check box if you would like to be marked as a permanent absentee voter while residing in the Choctaw Nation boundaries. Non-Residents: Applicants residing outside of the Choctaw Nation 10 ½ county service area will be registered as an absentee voter and will receive all ballots by mail. If you live outside of the Choctaw Nation boundaries, you may affiliate with ONE of the districts below, however, it is not required. If you affiliate with a district, you will vote by absentee ballot when there is a Council Member election for that district. Once you affiliate you must remain in the district you have chosen, unless you move into the Choctaw Nation boundaries. If you choose not to affiliate, you will vote by absentee ballot only when there is an election for Chief of the Choctaw Nation.
PLEASE CHECK THE PROPER DISTRICT ● Precincts (see 2nd page for map of Choctaw Nation boundaries and districts) District 1 ● Idabel ● Valliant
District 7 ● Antlers ● Rattan ● Wright City ● Choctaw Council house
District 2 ● Broken Bow ● Bethel
District 8 ● Hugo ● Boswell ● Fort Towson
District 3 ● Burkhart ● Smithville ● Talihina ● Heavener
District 9 ● Bennington ● Durant ● Calera
District 4 ● Poteau ● Spiro ● Summerfield ● Heavener
District 10 ● Atoka ● Kiowa ● Caddo
District 5 ● Stigler ● Kinta ● Keota ● Spiro
District 6 ● Buffalo Valley ● Red Oak ● Wilburton ● Quinton
District 11 ● Hartshorne ● McAlester ● Kiowa
District 12 ● Coalgate ● Crowder ● Atwood ● Arpelar
ADDRESS RELEASE AUTHORIZATION
Would you like your name and address released to candidates who run for Choctaw Nation Chief and Tribal Council?
YES (I want my name and address released)
NO (I do not want my name and address released)
___________________________________________________ Signature (indicate relationship, if other than applicant)
Revised 6/8/15
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